Case study

This key considerations document, developed by UNICEF and WHO, expands on the 2020 “last mile” operational guidance, with specific considerations for countries with lower HIV prevalence. It builds on the experiences of countries that have been validated for EMTCT of HIV and syphilis and translates the valuable lessons and promising practices of these countries into an operational framework for national programmes, consisting of 12 strategies and enablers to guide efforts towards Fast-Tracking EMTCT in lower prevalence countries.

It is based on a review of experiences, key lessons learned and promising practices in implementation of EMTCT interventions in lower prevalence countries, including Sri Lanka and Thailand, which have been validated by WHO for having eliminated vertical transmission of HIV, and three countries with the potential to achieve EMTCT by 2030: the Democratic Republic of the Congo, Ghana and India.

This brief reviews existing resources and analyses potential bottlenecks for the processes in applying for EMTCT/Path to Elimination and to strengthen ongoing PMTCT programmes in such applications. Eight UNICEF priority countries were selected for the review: Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Ukraine, and Uzbekistan.

EGPAF, with funding and support from Unitaid and DNDi, is bringing new-to-market pediatric ARV formulations to full-scale implementation in eight African countries. We gathered and documented lessons learned from these eight project countries to inform, streamline and accelerate the introduction and roll-out of new, child-friendly ARVs so that all children living with HIV have access to optimal, WHO-recommended treatment and care.

This document was developed to compile knowledge, insights and recommendations from UNICEF focal points in country offices implementing a project aimed at introducing, scaling up, and integrating point-of-care (POC) diagnostics into national health systems.The project was implemented by UNICEF, CHAI and ASLM with funding from Unitaid in 10 sub-Saharan African countries between 2016-2020. As the project was winding down, we thought it was important to document the lessons learned from those with direct, hands-on experience in project implementation to offer guidance to other countries interested in adopting POC technologies to increase access to diagnostics.

Innovative POC diagnostics can be a game changer in health systems as it enables testing outside the laboratory and closer to patients, can be used for the diagnosis of multiple diseases, addresses key limitations of conventional laboratory networks, and significantly increases access to diagnostic testing in a decentralized fashion. Decentralization of testing also carries an additional benefit as it strengthens elements of the health system around diagnostics (e.g., supply chain management, quality management, connectivity and data management, waste management) that have a broader impact on the health system. The multi-disease testing capacity of POC devices also contributes to pandemic preparedness and response, as has been shown by its use in the Ebola outbreak in West Africa (2014-2016) as well as its widespread use during the COVID-19 pandemic.

The impact of POC diagnostic technologies cannot be overstated. This is particularly important in communities in low-resource settings with limited access to diagnostics as well as patients whose clinical management depends upon quick diagnostic test results – such as children infected with HIV. Without treatment, up to 50 per cent of children living with HIV die by their second birthday, with a peak mortality between two and three months of age. Thus, HIV-exposed infants need to be diagnosed before two months of age using molecular diagnostic methods until recently only available in conventional laboratories. However, such conventional laboratory systems carry inherent limitations that restrict their ability to provide timely results in various settings, particularly low-resource settings. It was this urgent need to diagnose HIV-positive infants and initiate them on treatment as soon as possible that motivated this project. POC diagnostics introduction and scale up allowed faster diagnosis, which in turn increased the number of HIV-infected children diagnosed and initiated on treatment within two months of age.

Although the project was focused on increasing access to early infant diagnosis of HIV through POC testing, it also demonstrated the cost-effectiveness of POC diagnostics and the benefits of multi-disease testing by integrating HIV viral load and TB testing on the same POC diagnostic platforms. In spite of the focus on HIV, the lessons reported here are broadly relevant for other disease programmes. These lessons are organized in seven main topics: (1) Leadership commitment and support; (2) Laboratories and the supply chain; (3) Engagement with civil society organizations(CSOs); (4) Diagnostics network optimization (DNO); (5) Innovative approaches; (6) Transition to national governments and other long-term funding partners; and (7) Grant design and management. These lessons build upon the 'Key Considerations for Introducing New HIV Point-of-Care Diagnostic Technologies in National Health Systems' published in 2017, and 'Lessons Learned from Integrating Point-of-Care testing Technologies for Early Infant Diagnosis of HIV into National Diagnostic Networks' published by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in 2019. Together, these resources offer a comprehensive perspective on the strategies, challenges, and lessons learned in the course of integrating POC diagnostics into national health systems that countries should consider when introducing and/or scaling up POC diagnostics.

 

Accelerating Access to Innovative Point-of-Care HIV Diagnostics

English - French

In 2019 it was estimated that 1.2 million children (0-14) were living with HIV in Eastern and Southern Africa, yet more than a half million of these children (504,000) were not receiving lifesaving treatment. Children with HIV need to achieve viral load suppression if they are to lead long and healthy lives. Population-based surveys in Malawi, Uganda and Zimbabwe found that children on treatment fare worse in achieving viral load suppression compared to adults; 42 per cent vs 67 per cent, 39 per cent vs 84 per cent and 47 per cent vs 86 per cent respectively. Ending AIDS will not be possible without accelerating progress for children.

UNICEF, in collaboration with governments and partners, supported a mixed method study that included literature review, assessment of laboratory data in Malawi, Uganda and Zimbabwe and interviews with health workers and caregivers in Malawi to find out what is behind these low rates. The study found that one out of every three children who had a viral load test had not achieved viral load suppression. Support networks for caregivers and children improved adherence and made a difference towards outcome. The full report describes the methodology, key findings, challenges and proposes concrete recommendations to improve treatment outcomes for children with HIV. The accompanying advocacy brief summarizes the key findings and provides action-oriented next steps

This guide developed by Pediatric-Adolescent Treatment Africa (PATA) draws on lessons learned on integrating peer support strategies across several programmes in sub-Saharan Africa. It has been designed as an informative resource for the integration of peer support into HIV models of care for adolescents and young people in facility- and community-based settings. This toolkit is aimed primarily at health providers, specifically health facility managers and organizations engagement peer support programmes to strengthen health care./p>

In partnership with the Global Fund for AIDS, Tuberculosis and Malaria, UNICEF has supported the governments of Botswana and Lesotho to implement targeted programmes for adolescent girls and young women. In Lesotho, a national multi-sectoral referral framework is strengthening community-facility linkages and is catalyzing increased access to HIV/SRH services by guiding adolescent and young people to appropriate services and care. In Botswana, a radio drama series together with peer education components is tackling tough issues adolescents are facing in love, life and relationships. Documentation of both experiences are available for download.

Recognizing the harmful impact that COVID-19 and related lockdown measures pose for the HIV response, governments across ESA region are implementing interventions to sustain hard won gains toward ending AIDS. UNICEF country offices in support of governments and in collaboration with community and international partners have stepped up with evidence-driven and innovative interventions to protect continuity of HIV services. This compendium provides a summary of the innovative approaches being taken across nine HIV priority countries, Botswana, Eswatini, Kenya, Lesotho, Namibia, South Africa, Tanzania, Uganda and Zimbabwe. 

Community and primary health facility platforms have been recognized as important, but under-utilized entry points to address the large prevention, case detection and treatment gaps faced by young children with TB and/or HIV. In 2014, WHO and UNICEF revised community health worker packages for integrated community case management (iCCM) targeting children under five years of age, to include screening and referral for TB and HIV (TB/HIV iCCM). As part of an integrated, child-centered approach, TB/HIV iCCM is recommended for use in high TB and HIV burden settings.

Developed by UNICEF and Save the Children, Lessons from the Field (Uganda, Nigeria, Malawi) and Guidance (under development) are available for download.